The Supreme Court has ruled. Surprisingly, Justice Roberts agreed with the four more liberal members of the Court that the individual mandate, or more precisely, its penalty for not buying insurance, was an appropriate exercise of Congress’ taxing power. More importantly, however, for those who believe in limited government powers and individual freedom and responsibility, Justice Roberts agreed with the four more conservative members of the Court that the individual mandate was not an appropriate exercise of Congress’ power under the Commerce Clause. The majority of the Court also found that Congress’ attempt to intimidate the states by taking away Medicaid funding if they didn’t agree to the expansion was unconstitutional, which effectively ends the Medicaid expansion.
This decision is the worst outcome the President and his party could have feared. The law they insisted was not a tax was upheld only because the individual mandate penalty was found to be a tax. The general power of Congress to compel individual behavior under the Commerce Clause, advocated by the Administration, was properly noted to be non-existent in our Constitution. The Medicaid expansion is gone–the majority of states cannot afford it and now can’t be forced to do it. The Republican National Committee is already out with ads featuring the President saying the law was not a tax and claiming it would reduce costs, which it has not and will not. The Tea Party was formed from opposition to the PPACA and its adherents will now see the President’s defeat as the only option for its elimination. The PPACA was not “reform”, it was doubling down on all the things that have made our system so expensive–eliminating individual responsibility for health and health care costs, having even more government paid health care and encouraging provider market power that drives unit prices up; and those unit price increases have been found over and over again to be the main source of health care cost inflation. The law may have survived, but this decision makes it less likely that President Obama’s Administration will.